Skills

Employ­ment His­tory: Give names & addresses of past employ­ers. If you are now work­ing, present employer and rea­son for desire job change must be included. Also give rea­son for any lapse of time between jobs.

May We Con­tact Your Cur­rent Employer?

Yes
No

Emplyer (Lat­est First)

Name

Start Date

End Date

Com­plete Address City, State, & Zip

Final Wage

Name & Phone Num­ber of Supervisor

Title & Duties

Rea­son For Leaving

Name

Start Date

End Date

Com­plete Address City, State, & Zip

Final Wage

Name & Phone Num­ber of Supervisor

Title & Duties

Rea­son For Leaving

Name

Start Date

End Date

Com­plete Address City, State, & Zip

Final Wage

Name & Phone Num­ber of Supervisor

Title & Duties

Rea­son For Leaving

Upload Addi­tional Work His­tory As Needed. Word Doc

Mil­i­tary Service

Branch & Final Rank/Grade

Spe­cialty & Reserve Status

Gen­eral Information

Have You Ever Worked For This Com­pany Before?

Yes
No

If Yes, When & Where

Do you have any rel­a­tives employed by our company?

Yes
No

If Yes, Who? First & Last Name.

Have you ever been con­victed or pleaded guilty to a felony

Yes
No

If Yes, Give Full Detail.

Do you have a valid driver’s license?

Yes
No

If Yes, Give State & Class

Do you have a cur­rent driver’s med­ical card?

Yes
No

If hired, can you fur­nish proof of age and that you are legally enti­tled to work in U.S.?

Yes
No

How did you hear about the position?

Face­book
Reaper
Web­site
Phone
Radio

Employee

Do you have any health prob­lems that would inter­fere with the per­for­mance of your job?

Yes
No

If Yes, Describe.

Are there any other exper­ineces, skills, or qual­i­fi­ca­tions which you feel would espe­cially fit you for work with this company?

Upload your Resume Word Document

PLEASEREADTHEFOLLOWINGCAREFULLYBEFORESIGNINGBELOW This appli­ca­tion is con­sid­ered cur­rent for 90 days. If you want to be con­sid­ered for employ­ment affter this time you must resub­mit your application.

I cer­tify that the infor­ma­tion con­tained in this appli­ca­tion and/or any sup­ple­ment thereto, is cor­rect to the best of my knowl­edge and under­stand that any mis-statement or omis­sion of infor­ma­tion is grounds for ime­di­ate dis­missal in accor­dance with cmpany pol­icy. I autho­rize Larsen’s Ace Hard­wareto con­tact my cur­rent or prior employ­ers and/or the above ref­er­ences and request any infor­ma­tion con­cern­ing my pre­vi­ous employ­ment and any per­ti­nent infor­ma­tion they may have, per­sonal or oth­er­wise, and I expressly release Larsen’s Ace Hard­ware and all par­ties pro­vid­ing such infor­ma­tion from any and all lia­bil­ity or respon­si­bil­ity for dam­age that may result from fur­nish­ing the same to you. I fur­ther under­stand said back­ground check may also involve the con­many abtain­ing any inves­tiga­tive con­sumer report on me which may cover such areas as my char­ac­ter, gen­eral rep­u­ta­tion and mode of liv­ing. I hereby autho­rize the com­pany, if they wish, to make such inquiry and under­stand that upon my writ­ten request, addi­tional infor­ma­tion as to the nature of said inquiry will be pro­vided. If I am offered a posi­tion with the com­pany, I agree to con­form to the applic­a­ble rules, reg­u­la­tions, and poli­cies of the com­pany, and acknowl­edge that my employ­ment and com­pen­sa­tion can be ter­mi­nated at any time with or with­out cause, and with or with­out notice, at the option of either the com­pany or myself. I fur­ther under­stand that no rep­re­sen­ta­tive of the com­pany has any author­ity to make any agree­ment con­trary to the fore­go­ing or to bind the com­pany for the employ­ment of any per­son for any spec­i­fied period of time.

Full Name

* By typ­ing my name & check­ing this box, I cer­tify that all the above is truth­ful. I also agree to all the terms set out in the terms of employ­ment para­graphs above.